Lubricating the Insertion Funnel with Autologous Fat Tissue for Inserting Breast Implants.

Abstract

During the procedures of breast augmentation or reconstruction, to smoothly insert a breast implant into the implant pocket without much resistance is a challenge. The surgeon has to avoid forcefully squeezing the implant and meanwhile to adopt “no touch” technique.1 One of the devices to overcome the issue is the Keller Funnel. However, it is still problematic to use the Keller Funnel for inserting a textured implant because of the highly adherent surface.2 Additional lubricants are usually applied, for example, lidocaine hydrochloride 2% jelly or EMLA cream.3 But these lubricants are used off-label, and potential allergy reaction or foreign body reaction raises a concern of safety.4 Furthermore, because Asian women usually ask for small surgical incisions due to their tendency of developing scar tissue and hyperpigmentation, transaxillary or transumbilical breast augmentation is preferable.5 Obviously, the transaxillary or transumbilical approach requires a longer distance between the surgical incision and the implant pocket. These demands much increase the challenge of smoothly inserting the implants. Therefore, we introduced an easy technique to use autologous fat tissue as lubricant for the Keller Funnel to facilitate inserting breast implants. Patients were placed in supine position for receiving general anesthesia. Based on the planned approach, implant pocket was prepared as a standard protocol. Then, autologous fat tissue was harvested with the use of a tumescent technique. The site of fat harvesting could be flexibly determined by the patient’s needs. Before liposuction, the harvest site was infiltrated with 50 ml of tumescent fluid, which was prepared by adding 10 ml lidocaine (2%) with epinephrine (1:50,000), 5 ml sodium bicarbonate (7%) in 500 ml Lactated Ringer solution. Liposuction was performed with a 3-mm aspiration cannula, which was connected to a low pressure suction system (50 kPa). The lipoaspirate and tumescent fluid were kept in the syringe. Further fat preparation was not necessary to avoid contamination. Approximately 15 mL of lipoaspirate was sufficient to lubricate each funnel and pocket. The next step was to cut the Keller Funnel to the appropriate tip diameter and to hydrate the funnel as in the manufacturer’s instructions. Before pouring breast implants into the funnel, the lipoaspirate was squirted from the syringe into the insertion funnel and the pocket for lubricating (Figs. 1, 2). The following procedures were the same as the standard protocol including placing the funnel tip inside the implant pocket, propelling the implant into the pocket, checking the implant position, and closing the wound.Fig. 1.: Squirting the autologous fat into the Keller Funnel for lubricating.Fig. 2.: Pouring the breast implant into the Keller Funnel, which has been lubricated by autologous fat.There has been a large amount of evidence addressing the safety of autologous fat grafting, as it has been increasingly used in cosmetic breast augmentation. The use of autologous fat to lubricate the insertion funnel is an easy technique for smoothly inserting breast implants and is free from the risk of foreign body reaction and allergy. The technique could be combined with any insertion devices and applied in any approaches of breast augmentation or reconstruction.